Can I Dive with Sleep Apnea?

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Q) Hello DocVikingo,

I have had sleep apnea for over 10 years and have no problems. I use a CPAP (continuous positive airway pressure) machine every night. Is there any problem with me starting buy generic cialis 20mg diving?

(A) Hi L…

You don’t mention whether you have obstructive (OSA) or central sleep apnea (CSA), although the former is much more likely.

In either event, it essentially depends upon how well controlled the condition is and the presence of any worrisome signs and symptoms. Uncontrolled sleep apnea can increase the risk for high blood pressure and for heart attack, heart failure and irregular heartbeat. Also of concern to the diver, it can result in sleep deprivation and hypoxia that can impair attention, concentration, memory, and information processing and psychomotor speed.

Moreover, the diver with untreated, improperly treated or unresponsive sleep apnea probably has abnormal levels of CO2. These high levels of CO2 can be further elevated by diving at depth and increase the risk of nitrogen narcosis and of CO2 and O2 toxicity.

BTW, the nasty snoring that may accompany this disorder also can result in one’s significant other severely beating the affected person about the face and body during sleep.

This item that appeared in an Australian daily newspaper may prove informative:

“Coroner raps doctor over diver’s death April 24, 2009

A doctor should have more thoroughly investigated a man’s sleeping disorder before clearing him as medically fit to dive, an inquest has found.

Queensland coroner Michael Barnes found Dr Greg Emerson could have further queried Dr Stephen Broe’s sleep apnoea before certifying him as fit to undertake specialty deep dives in early 2005.

Dr Broe, 45, died on April 28, 2005, shortly after completing a dive to a depth of 50 metres off the coast of Moreton Island near Brisbane.

The inquest, held in Brisbane in March, was told Dr Broe had just completed the final dive in a technical deep-diving course when he immediately complained of burning pain in his chest and severe shortness of breath.

Despite assistance from people on the boat, Dr Broe lapsed into unconsciousness and died a few minutes later.

Mr Barnes on Friday found Dr Broe’s cause of death was decompression sickness, also known as The Bends.

In his findings, Mr Barnes said the effect of Dr Broe’s sleep apnoea on his ability to perform deep dives should have been further investigated.

However, he made no recommendations Dr Emerson be referred to the Medical Board, saying there was “no evidence the doctor was lax or cavalier” in his assessment of Dr Broe.

In his findings, Mr Barnes said diving doctors rarely come across sufferers of sleep apnoea.

Mr Barnes recommended a review of dive medical guidelines in light of evidence given during the inquest.

He also suggested the dive industry review how deep divers exit the water, saying the current standard practice for them to climb onto the back of the boat may place them under unnecessary exertion. AAP”

It should be noted that the article doesn’t mention what, if any, treatment the diver was undergoing for his sleep apnea. The individual who is being properly treated (e.g., CPAP) and responding well, has no worrisome nasal or other upper airway problems, and has none of the other conditions that can be related to obstructive sleep apnea and could raise the risk of SCUBA (e.g., depression, obesity, poor physical conditioning/abnormal exercise tolerance, pulmonary hypertension and other cardiac problems, sleepiness/lack of full alertness) should be able to dive safely.

I know of at least one diving medicine doctor who recommends a max depth of 60′ because of the gas pressure changes that occur at depth, but IMHO this may overly conservative in the diver who is in a state of good general health and fitness and entirely without signs or symptoms of sleep apnea beyond the defining feature of prolonged periods of significantly slowed or absent breathing while asleep.

Regards,

DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
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9 comments for “Can I Dive with Sleep Apnea?

  1. Bob Halstead
    January 11, 2011 at 6:51 am

    I had obstructive Sleep Apnoea – with snoring – and tried to use a CPAP machine – but found it ridiculous, and impossible to tolerate although I am sure they work if you can put up with them. They are also heavy and not suitable for carrying on dive trips.

    Instead I had my dentist fit me with a mandibular advancement splint (SomnoMed). They look a bit like teeth protectors, easy to use – and carry on dive trips – and they work by moving the bottom jaw forward a little while you sleep. I also lost 12Kg in weight. I recommend splints, and weight loss, for divers with a Sleep Apnoea or snoring problem.

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  2. DocVikingo
    January 11, 2011 at 2:24 pm

    Good points, Bob.

    Regards,

    Doc

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  3. Richard
    January 12, 2011 at 1:08 am

    I have sleep apnea, I have been using a CPAP for 6 plus years, I am 55 and in good health. Diving has not been affected as when I am awake I breathe fine. The key is to be fit, not overweight or in poor health as that would be the limiting factor not the CPAP to your ability to dive.

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  4. John Bantin
    January 14, 2011 at 9:23 pm

    I used to suffer terribly with obstructive sleep apnea but it ceased when my first wife stopped putting a pillow over my face while I was asleep.

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  5. wrxbob
    February 23, 2011 at 12:47 pm

    I’m 59(will be 60 in May)and suffer sleep apnea as well as type 2 diabetes.I’ve been diving for the last 19 years and have no problems going diving.I’m 6’4″ and try to keep my weight around 210-215(my ideal max weight should be 205 according to all the statistics).My deepest dive has been to 220′(only tried that stunt once).My buddy who is a pediatrician(never leave home without him/her)and I try to go diving 3-4 times a year.I take my cpap machine with me on EVERY dive trip I make(its a zzzpap machine and it all fits in a lunch box stile soft bag).My wife has stopped kicking me at night ever since I got the cpap machine about 4-5 years ago.I don’t have a problem wearing the cpap machine mask(I think it has something to do with the fact I’m accustomed to wearing a diving mask since I was 19-20 when I first started snorkeling).I take metformin for the diabetes and try to watch what I eat so I don’t eat too much crap which is unhealthy.Other than that,life is good under the sea.

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  6. Ivan Seligman
    April 27, 2011 at 1:39 am

    There is more to this case that is very educational, although rather technical reading. The actual coroner’s inquest is available at:
    http://www.courts.qld.gov.au/BroeSJ20090424.pdf

    I find that Mr. Barnes, the Coroner, a lawyer not a medical doctor, did a thorough job in enlisting the assistance of various experts in assessing the deceased diver’s medical history, diving risks, dive computer, gas mixture, etc., and formulationg a cause of death. Even when “diving by the book”, complications may occur.

    I feel that most cautious, conservative dive-familiar physicians would have medically cleared this diver for the planned dives. The diver himself, a physician diving with two, not one dive computers, seemed to be reasonably prudent and risk adverse as well. I think we’ve all dived with middle-aged divers in similar shape who had no problems. Proof, of sorts…he did well on all of his prior 130 dives. Additionally, “He was certified as a recreational scuba diver in 2003 and subsequently completed numerous other courses offered by Prodive. These included certification as an Open Water Diver, Wreck Diver, Deep Diver, Rescue Diver, Enriched Air Nitrox (Max 40% Oxygen) Diver, Equipment Specialist and SCUBA Air Fill Operator. These courses satisfied the skill pre-requisites for entry to the Technical Deep Diver Course which he was undertaking at the time of his death.”

    Although the chest pain and subsequent death was reasonably felt to be due to decompression illness, it could also have been due to myocardial infarction or an arrhythmia/dysrrhythmia in an overweight man who carried over 40 kg of tanks after the dive. While this alone is not too much for a reasonable similar man to carry, it is too much if it is the “straw that broke the camel’s back.”
    Case in point, years ago, a 75 year old woman I knew normally carried two grocery bags from her car upstairs to her apartment each week. Then, she carried an additional 4 liters of soft drink as well in her arms, and suffered severe chest pain which was found to be a massive heart attack (myocardial infarction). While this anecdotal event does not prove or disprove the coroner’s findings, it just indicates that a little added weight or stress at the “right/wrong time” could be a “camel’s straw” for some.

    Decompression illness as a cause of death works fine, too. It also shows how despite any dive algorithm, set of tables or dive computer profile, one person may suffer fatal decompression illness (“the bends”) while his other companions on the same dive are completely unaffected. “Your mileage may vary.”

    I find the history of sleep apnea to be more of a “red herring”, rather than a contributory factor, especially in view of the history of the diver’s 130 prior dives.

    I’ve been on a dive boat with a gentleman with profound sleep apnea (many bouts while sleeping of not breathing for over 50 seconds followed by terrifying loud gasping)that didn’t seem to interfere with his diving, Still, at night, as with John Bantin’s wife, his noise led others to consider various methods of silencing him with pillows or hot lead injections.

    This unfortunate case indicates the rare yet possibly fatal risks of diving, especially when going to technical diving depths, for a cautious diver in less than ideal physical shape, despite following accepted dive profiles. Similarly, his “identical twin” could have also suffered chest pain and a heart attack by jogging, or lifting more weights than usual. Despite careful planning, life is not risk-free.

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  7. Arianne Sondag
    July 9, 2012 at 12:44 pm

    Sleep disorders can also be prevented by having a good exercise everyday. Exercise can relax the body and thus helps you sleep better. ‘”:.` visit our favorite web site

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  8. Brad Clowers
    February 6, 2013 at 11:34 am

    Cigarette smokers who also experience obstructive sleep apnea need to make a tricky selection. Studies have shown that using tobacco can aggravate resting difficulties for example heavy snoring and apnea, so those that want to light up must really consider on their own and decide precisely what is more essential, pure nicotine or possibly a fantastic night’s sleep at night.

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  9. terry s
    July 28, 2016 at 9:08 pm

    Dr V:
    Does mild untreated sleep apnea compromise a recreational diver’s ability to off gas nitrogen?

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